Not surprisingly, smokers who abstain for four weeks before receiving surgical incisions are less likely than continuous smokers to experience wound infection or wound rupture. What was found surprising in a recent study by Danish researchers was that healing rates were similar between abstinent smokers who used a nicotine patch and those who used placebo patches.

In a 15-week study of 48 smokers and 30 persons who had never smoked, Sorensen and colleagues randomized smokers . . .

A key question raised by Yang and Longaker in an accompanying editorial is why use of a nicotine patch did not cause the same "wound-healing defect" found in the subjects who continued to smoke. Hypoxia, an important obstacle to wound healing, may well be "secondary to the vasoconstrictive effects of nicotine," they acknowledge. However, the current findings suggest, factors other than nicotine's effects appear to be involved in tissue hypoxia and its role in wound infection and wound healing.

The editorialists suggest that further study be devoted to measuring arterial blood gases and local cutaneous oxygen tension in smoking and nonsmoking surgical patients.